Provider Demographics
NPI:1528091527
Name:BREAST IMAGING ASSOCIATES, P.S.
Entity type:Organization
Organization Name:BREAST IMAGING ASSOCIATES, P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGARAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-688-5985
Mailing Address - Street 1:PO BOX 24905
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-0905
Mailing Address - Country:US
Mailing Address - Phone:888-846-5527
Mailing Address - Fax:607-324-2369
Practice Address - Street 1:1135 116TH AVE NE
Practice Address - Street 2:SUITE 250
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-4623
Practice Address - Country:US
Practice Address - Phone:425-688-5985
Practice Address - Fax:425-467-3685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7112964Medicaid
WACK3107OtherRAILROAD MEDICARE GRP
WA3307453OtherAETNA GRP
WA8937366OtherL & I CRIME VICTIMS GRP
WA162226OtherL & I WORKERS COMP GRP
WA7112964Medicaid